Evidence-based Clinical Guidelines for Acute Dental Pain in Children

A panel put together by the American Dental Association Council on Scientific Affairs, American Dental Association Science and Research Institute, University of Pittsburgh School of Dental Medicine, and Center for Integrative Global Oral Health at the University of Pennsylvania have developed seven recommendations and five good practice statements after a review to determine the effect of pain medication on managing acute dental pain in children. The systemic review and guidelines were published in the Journal of the American Dental Association for dentists to find and follow. Dentists should take some time to review these guidelines and modify their prescription of pain medication to children as needed.

The panel followed a similar method to the recent review on caries lesion literature, the G.R.A.D.E. framework, to assess their evidence and formulate their recommendations, which were based on studies regarding the effects of analgesics and corticosteroids on children following extractions or the management of a toothache. According to the survey, 90% of children in the hospital before discharge were given an opioid to manage their pain, while 50% took acetaminophen and 18% took an NSAID.

Children need their pain managed, but they can experience adverse side effects when on opioids, compared to acetaminophen or NSAIDs, which are relatively low risk. The ADA’s guidelines are meant to assist clinicians, patients, and guardians when determining an appropriate use of pharmacological management of acute dental pain.

The primary item that the panel identified was a small beneficial net balance when using NSAIDs alone or in combination with acetaminophen compared to not providing pain relief therapy. Non-opioid medications, specifically NSAIDs, are recommended over opioids by the journal when managing acute pain. Remember to always check for contraindications between drugs like codeine and tramadol in children.

If you’d like to read more about the systemic review conducted by this panel, you can find it here.

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